Healthcare Provider Details

I. General information

NPI: 1174920441
Provider Name (Legal Business Name): PATRICK R. PICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST SUITE 304
OMAHA NE
68114-4108
US

IV. Provider business mailing address

PO BOX 10190
VIRGINIA BEACH VA
23450-0190
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-5048
  • Fax: 402-354-2585
Mailing address:
  • Phone: 800-477-5240
  • Fax: 757-216-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2019
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: